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Clinical Factors That Potentially Affect the Treatment Outcome of Helicobacter pylori Eradication Therapy with using a Standard Triple Regimen in Peptic Ulcer Patients

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°­°æÇÊ ( Kang Kyung-Phil ) - ºÐ´ç¼­¿ï´ëÇб³º´¿ø ³»°ú
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Abstract

¸ñÀû: ¼ÒÈ­¼º ±Ë¾ç ȯÀÚ¿¡¼­ Helicobacter pylori (H. pylori) Á¦±ÕÀº Ä¡·á ¹× Àç¹ß ¹æÁö¿¡ °¡Àå Áß¿äÇÑ Ä¡·áÀÌ ¸ç, Ç¥ÁØ »ïÁ¦¿ä¹ý¿¡ ÀÇÇÑ Á¦±ÕÀ²Àº ¾à 80%·Î ÃÖ±Ù Á¡Á¡ °¨¼ÒÇÏ´Â Ãß¼¼ÀÌ´Ù. º» ¿¬±¸¿¡¼­´Â H. pyloriÀÇ Á¦±Õ¿¡ ¿µÇâÀ» ¹ÌÄ¡´Â ÀÓ»ó ÀÎÀÚ¸¦ ¾Ë¾Æº¸¾Ò´Ù.

´ë»ó ¹× ¹æ¹ý: 2004³â 7¿ùºÎÅÍ 2007³â 3¿ù±îÁö ºÐ´ç¼­¿ï´ëÇб³º´¿øÀ» ¹æ¹®ÇÏ¿© ³»½Ã°æÀ» ½ÃÇàÇÑ È¯ÀÚ Áß H. pylori¿¡ °¨¿°µÇ¾î Ç¥ÁØ »ïÁ¦¿ä¹ýÀ¸·Î Á¦±ÕÄ¡·á¸¦ ¹ÞÀº ¼ÒÈ­¼º ±Ë¾ç ȯÀÚ 597¸íÀ» ÈÄÇâÀûÀ¸·Î ºÐ¼®ÇÏ¿´´Ù. ¼ºº°, ¿¬·É, Èí¿¬·Â, À½ÁÖ·Â, ³»½Ã°æÀû ±Ë¾çÀÇ À§Ä¡¿Í Ȱ¼ºµµ, PPIÀÇ Á¾·ù µîÀÇ ÀÓ»ó Æ¯Â¡¿¡ ´ëÇØ Á¶»çÇÏ¿´°í, °¢ ÀÓ»ó ÀÎÀÚ¿¡ µû¸¥ Á¦±ÕÀ²À» ºñ±³ÇÏ¿´´Ù.

°á°ú: ¸ðµç ȯÀÚ¿¡°Ô PPI, amoxicillin 1 g, clarithromycin 500 mgÀ» 1ÀÏ 2ȸ, 7Àϰ£ Åõ¾àÇÏ¿´´Ù. Àüü Á¦±ÕÀ²Àº 80.2%¿´À¸¸ç, 60¼¼ ¹Ì¸¸(83.2%), ½ÊÀÌÁöÀå±Ë¾ç ȯÀÚ(82.5%)°¡ °¢°¢ 60¼¼ ÀÌ»ó(73.3%), À§±Ë¾ç ȯÀÚ(73.6%)º¸´Ù À¯ÀÇÇÏ°Ô ³ôÀº Á¦ ±ÕÀ²À» º¸¿´´Ù(p=0.005, p=0.041). Àüü ¼ÒÈ­¼º ±Ë¾ç ȯÀÚ¿¡¼­ ¼ºº°, Èí¿¬·Â, ³»½Ã°æÀû ±Ë¾çÀÇ À§Ä¡¿Í Ȱ¼ºµµ, PPIÀÇ Á¾·ù¿¡ µû¸¥ Á¦±ÕÀ²Àº À¯ÀÇÇÑ Â÷À̰¡ ¾ø¾ú´Ù. À§±Ë¾ç°ú ½ÊÀÌÁöÀå±Ë¾çÀ» µû·Î ±¸ºÐÇÏ¿© ºÐ¼®ÇÏ¿´À» ¶§, À§±Ë¾çȯÀÚ¿¡¼­´Â 60¼¼ ¹Ì¸¸ÀÇ È¯ÀÚ(81.3%)°¡ 60¼¼ ÀÌ»óÀÇ È¯ÀÚ(62.7%)º¸´Ù À¯ÀÇÇÏ°Ô ³ôÀº Á¦±ÕÀ²À» º¸¿´À¸¸ç(p=0.008), ½ÊÀÌÁöÀå±Ë¾çȯÀÚ¿¡¼­´Â ºñÈí¿¬ÀÚÀÇ Á¦±ÕÀ²(84.2%)ÀÌ Èí¿¬ÀÚ(73.8%)º¸´Ù À¯ÀÇÇÏ°Ô ³ô¾Ò´Ù(p=0.046).

°á·Ð: ¼ÒÈ­¼º ±Ë¾ç ȯÀÚ Áß °í·É, À§±Ë¾çÀ» °¡Áø ȯÀÚ¿¡¼­ H. pylori Á¦±ÕÀ²ÀÌ ³·¾Ò°í, À§±Ë¾ç Áß¿¡¼­ °í·É, ½ÊÀÌÁöÀå ±Ë¾ç Áß¿¡¼­ Èí¿¬ÀÚ°¡ Á¦±ÕÀ²ÀÌ ³·¾Ò´Ù. ÀÌ·¯ÇÑ È¯ÀÚµéÀÇ ³·Àº Á¦±ÕÀ²À» ³ôÀ̱â À§ÇØ Á¦±Õ Ä¡·á±â°£À» ´Ã¸®°Å³ª, »ïÁ¦¿ä¹ýÀÇ Ä¡·áÈ¿°ú¸¦ Áõ°¡½Ãų ¼ö ÀÖ´Â º¸Á¶ ¾àÁ¦ÀÇ Åõ¿© µîÀ» °í·ÁÇØ¾ß ÇÒ °ÍÀÌ´Ù.

Background/Aims: Proton pump inhibitor (PPI) based triple therapy for Helicobacter pylori eradication has an approximately 20% treatment failure rate. The aim of this study is to examine the clinical factors that influence eradication of H. pylori in patients with peptic ulcers.

Methods: We reviewed the medical records of 597 endoscopy-proven peptic ulcer and H. pylori-positive patients who were treated at our hospital between July 2004 and March 2007. The eradication rate and the effect of age,gender,smoking,alcohol drinking, activity and the location of ulcer and the kind of PPIs were examined.

Results: 597 patients were treated with one-week triple therapy (PPI, amoxicillin 1 g, clarithromycin 500 mg all twice daily). The overall eradication rate was 80.2%. Eradication was significantly more successful in the patients with an age under 60, and in patients over 60 and who had a duodenal ulcer (83.2% vs 73.2%, respectively, p=0.005) or a gastric ulcer (82.5% vs 73.6%, respectively, p=0.041). There was no statistically significant difference according to gender, smoking, alcohol, the activity of the ulcer and the kind of PPIs.

Conclusions: An age over 60 and gastric ulcer were associated with a lower H. pylori eradication rate in patients with peptic ulcers. Therefore, H. pylori eradication in old age patients and in patients with gastric ulcer should be managed differently and the treatment duration should be extended or a new treatment regime developed to overcome the lower eradication rate.
(Korean J Gastrointest Endosc 2008;36:199-205)

Ű¿öµå

Helicobacter pylori;Á¦±Õ;¼ÒÈ­¼º ±Ë¾ç;ÀÓ»óÀÎÀÚ
Helicobacter pylori;Eradication;Peptic
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